Neurological manifestations of lympho-haematopoietic malignancies

Objective: Haematological malignancies are common in childhood.During their management, patients are at risk of a variety of complications involving various organ systems.This study focuses on the neurologic manifestations. Incidence of neurological manifestations in leukemia & lymphomas have been reported to vary between 20-40%. The neurological presentation is either because of primary or secondary effects of malignancy or side effects of treatments.The manifestations may be due to metabolic alterations, infections, direct invasion, or therapy related.These complications can occur anywhere from brain parenchyma to neuromuscular junction.

Methodology: This was an analytical, retrospective, study of patients registered over a period of 5 years.Records of patients of immuno-phenotypically confirmed malignancies were reviewed for neurological signs, symptoms, CSF, neuroimaging, treatment, progress.

Results: 67 patients with hematopoietic malignancy presented with neurological manifestations.Mean duration of neurological presentation since diagnosis of malignancy was 7 months.31/67 had encephalopathy,30/67 had seizures,14/67 had paraparesis and 10/67 had stroke. Neurological manifestations were categorized according to etiology, as disease related(CNS leukemia, Thrombocytopenia,hyperleukocytosis), chemotherapy related and manifestations secondary to infections(Viral,CNS tuberculosis or fungal). Methotrexate was the most common culprit in chemotherapy related complications.In disease related manifestations,14/67 had CNS leukemia & 8/67 had manifestations of hyperleukocytosis /thrombocytopenia.Viral meningoencephalitis was the most prevalent infection associated neurological problem during.Outcome analysis showed 43.3% with no residual morbidity,34% with residual morbidity,8% deaths,4.5% were lost to follow-up.

Conclusion: With this study, we could delineate pattern of presentation of neurological complications along with its temporal relationship thus making etiological diagnosis easy,helping in the management of these patients.